We bring fresh perspectives from nurses, doctors, emergency medical professionals, patients and their families, as well as others that care for children. Our goal is to raise awareness about the issue of pediatric trauma.

Wednesday, June 18, 2014

Trauma remains the leading cause of death and
disability for children in the United States. Motor vehicle crashes contribute
to a huge portion of such traumatic injuries in children, and cause over 50 percent of traumatic injury deaths of children. While most research regarding children
in motor vehicle crashes focuses on preventing injuries, my research group
recognizes that prevention is not 100 percent effective. Therefore, we chose to
focus our efforts on the treatment of children injured in motor vehicle crashes
when prevention fails.

One of the most important factors in the
treatment of injured children is the process of trauma triage. Triage is the
process of transporting the “right patient to the right place at the right time.”
The “right place” depends on the severity of the child’s injuries.For severely injured patients, the right
place is usually a specialized trauma center, where doctors specialized in the
treatment of traumatic injuries are on-call 24 hours a day.Failure to identify these children in need of
treatment at a trauma center can result in disability and death. However, it is
not practical to send every child to a trauma center.This would put an undue strain on the trauma
system’s resources and may thus impair care of those more seriously injured
patients.

Currently, most triage systems rely on
assessment of the child after Emergency Medical Technicians (EMTs) have already
arrived on the scene. EMTs assess the child, determine the severity of the
injuries and decide whether or not they need to be transported to a trauma
center. This is problematic for several reasons. First, the assessment and
determination of whether or not a child needs transport to a trauma center may
be highly subjective. Second, it may be impossible to determine, based on the
limited diagnostic tools available in the field, the specific injuries a child
has sustained and thus how severe they actually are. Third, this process may be
long and arduous for children in rural areas who often live long distances from
trauma centers. Such children would require transport by helicopter to the
nearest trauma center. By the time the EMT team arrives on the scene,
determines helicopter transport is necessary and sends for such transport, critical
time is wasted that is best spent treating injuries.

For these reasons, some began to wonder if it
would be possible to determine which children injured in motor vehicle crashes
were likely to need treatment at a trauma center with a systematic approach
even before EMTs arrived at the scene. Such a system could eliminate
some of the bias of the current subjective triage process and could save
precious time for children living in rural areas. This could be accomplished
through an Advanced Automotive Crash Notification (AACN) system. While AACN
systems have been developed for adults, no such systems have been developed
specifically for children.

Our research is focused on creating an AACN system
that will help EMTs decide which children need treatment at a trauma center
after a motor vehicle crash. AACN systems use information
recorded in a vehicle at the time of the crash, such as speed and direction of
impact. They can then use this information to predict the severity of the
injuries occupants in the vehicle are likely to have sustained. This
information can be transported from the vehicle’s black box to EMTs so that the
appropriate resources can be immediately utilized. AACN will not replace the
ability of EMTs to assess and treat children but will improve the ability with
which they can do so quickly and correctly.

We hope that our AACN system can help improve
the care of children injured in motor vehicle crashes throughout the U.S.,
making it possible to get many more of them to the right place at the right
time, no matter where they are injured.

Wednesday, June 11, 2014

With hot summer days already upon us, the thoughts of many turn to family car trips and vacations.
But as the weather warms, please also remember that leaving a child in a car
is never safe and could lead to heatstroke. Too many Americans are not aware of
this deadly problem, with potentially two million children being left alone in a car and put at risk.

When outside
temperatures are in the low 80s the temperature inside a vehicle can reach
deadly levels in only 10 minutes, even with a window rolled down two inches. Young
children are particularly at risk because their bodies heat up three to five
times faster than an adult's.

When a
child's temperature reaches 107 degrees, that child dies. Last year alone, at
least 43 children in America died after being left in unattended vehicles—and
an unknown number of others were moderately or severely injured.

We clearly
need to do more to spread the message about the dangers of heatstroke.
According to a new study by Safe Kids Worldwide, 14 percent of parents stated
they have left a child alone inside a parked vehicle despite the risk of
heatstroke. That means that nearly two million parents transporting more than
3.3 million children may have intentionally left children in a parked vehicle
and risked their lives.

To make
Americans more aware of the dangers of heatstroke, the National Highway Traffic
Safety Administration is again conducting our "Where's Baby? Look Before
You Lock" campaign, which will be taking to the airwaves and the Internet
on May 5 and running through September. This year, on July 31, we’ll also be
conducting our second National Heatstroke Tweet Up Day to spread to word on
Twitter.

When I began thinking about this
year’s campaign, I immediately thought about reaching out to our friends at the
Childress Institute, their supporters, and the entire community that works to
care for injured children. As leaders in protecting children, I know that
you’ll do all you can to help us spread to word about heatstroke.

NHTSA and its
safety partners urge parents and caregivers to take the following precautions
to prevent heatstroke incidents from occurring:

Never
leave a child unattended in a vehicle – even if the windows are partially open
or the engine is running and the air conditioning is on

Make
a habit of looking in the vehicle – front and back – before locking the door
and walking away

Ask
the childcare provider to call if the child doesn't show up for care as
expected

Do
things that serve as a reminder that a child is in the vehicle, such as placing
a purse or briefcase in the back seat to ensure no child is accidentally left
in the vehicle, or writing a note or using a stuffed animal placed in the
driver's view to indicate a child is in the car seat

Teach
children that a vehicle is not a play area and store keys out of their reach.

Parents and
caregivers are the first line of defense against the needless heatstroke
tragedies but everyone has a role to play. NHTSA will be working with our
safety partners and local communities to get the message out to never leave
children unattended in a vehicle and always check the backseat before walking
away. If you see a child alone in a car, call 911 immediately.

When the weather
heats up it’s time for all of us to step up and prevent heatstroke. As a
community, we can prevent these deaths and injuries, and parents should always
remember: Look Before You Lock.

Thursday, June 5, 2014

As you saw in my post last week, my wife, Lisa, and I
were invited to attend President Obama’s Healthy Kids & Safe Sports Concussion Summitat the White House on May 29. We were
invited for several reasons and were able to bring together all of our
passions, including our work with The Matthew Gfeller Foundation, UNC’s Matthew
Gfeller Sport-Related TBI Research Center, and my role as executive director of
the Childress Institute for Pediatric Trauma. At the end of my post are a few
commitments these organizations have made in response to the President’s summit.

The power of the Presidential position brought a large
team of people to the White House that are interested in positively impacting
this invisible threat to our kids – medical professionals, sports
advocates/players (football, soccer, hockey, etc.), parents and other family
members, corporate supporters, the military, media and others.

The first speaker was Tori, a high school soccer star
with an opportunity to attend college and continue playing her sport. Unfortunately,
the effects of initially unrecognized and repeated concussions meant Tori’s
dream of playing soccer in college is over, but she is working hard to recover
and remains active in sports by teaching young children how to play soccer. She
eloquently told her story and introduced the President, which allowed him to
reference her experience as an example to other young athletes and parents
about the commitment ahead of us to change perceptions and improve outcomes.

“We’ve got to have better research, better data, better
safety equipment, better protocols,” said President Obama. “We’ve got to
have every parent and coach and teacher recognize the signs of
concussions. And we need more athletes to understand how important it is
to do what we can to prevent injuries and to admit them when they do
happen. We have to change a culture that says you suck it up. Identifying a concussion and being able to
self-diagnose that this is something that I need to take care of doesn’t make
you weak -- it means you’re strong.”

The President shared a very powerful and balanced
message: our kids want and need to play sports to be productive. The
collective “we” at the summit need to invest all we can, including treasure, talent
and time, to insure that they play safely. Sports and recreational TBI are the
invisible epidemic that demands attention right now across the board. Did you know that 70 percent of the U.S. football-playing population is younger than 14? Many people are talking about the NFL, but kids make up the majority of players and they are vastly understudied. It’s vital that we research ways to improve
outcomes. Until then, “when in doubt, sit it out,” and keep yourself informed.

The effort required is huge, but we must lead and move
with coordinated speed. Thanks for helping us share this initiative.

The Childress Institute funds research to improve the
treatment for critically injured children in the U.S., including an ongoing
study to measure head impacts that youth sustain while playing football.
The published results from 2013 comprised 111 youth football players ages 6 to
18 – the largest ever conducted. Players received an MRI before and after the
football season, and also wore helmets instrumented with sensors to measure
head impacts during practice and games. We will continue this study to
determine short- and long-term effects, and next steps.

We have developed an innovative behavior
modification program aimed at reducing the risk of sports-related concussion
in high school football athletes. This fall we will study the intervention by
employing a two-pronged approach in several North Carolina High Schools: 1)
quantitatively capture head impact biomechanics using accelerometer systems to
identify at-risk player profiles, and 2) employ a clinician-coach-player
mentorship approach to affect change in playing techniques to reduce risk of
concussions.

The Matthew Gfeller Foundation (MGF) was founded in 2009
after the death of our son who sustained a catastrophic TBI
during his first high school varsity football game in August 2008.
Matthew’s injury was caused by a severe helmet to helmet hit and he never
regained consciousness. The Matthew Gfeller Foundation’s mission is to help
prevent, recognize, and treat youth sports head injuries. The MGF works to raise
awareness and fund research and treatment centers through a variety of
community based programs. The MGF supports the following organizations in
furtherance of its mission: The Matthew Gfeller Sports Related Traumatic Brain
Injury Research Center at UNC-Chapel Hill, The Childress Institute for
Pediatric Trauma at Wake Forest University, and the high school athletic
trainers of Forsyth County, NC.